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A personality disorder can be defined as: A deeply ingrained, inflexible, maladaptive pattern of relating, perceiving and thinking serious enough to cause distress or impaired functioning. Personality disorders are usually recognizable by adolescence or earlier, continue throughout adulthood and become less obvious in middle or old age. Examples of formally identified personality disorders are antisocial, borderline, compulsive, histrionic, dependent, narcissistic, paranoid, passive-aggressive, schizoid and schizotypal. There are many different personality disorders but clustered into three different groupings are odd or eccentric behaviours; dramatic, emotional or erratic behaviours; and anxious or fearful behaviours. It is known that people who have these presentations, and are not diagnosed or supported, use mind and mood altering behaviours and substances to manage their life difficulties.
Everyone has a personality, so how do we go about defining that word, and how does a personality disorder present in someone’s life? It seems obvious, but it is hard to put into words. Part of the reason is that many of the words we use to describe people have wide meanings and these meanings often mean different things to different people.
These words can cover more than one area of experience. Anxiety describes the feeling of worrying, nervousness describes the behaviour that others might notice if you feel like this. Shyness describes the feeling of awkwardness with other people, but also the behaviour of being rather quiet in company, or being a little self-absorbed.
It is also difficult because the way we appear to other people can be very different in different situations. If you only know someone from work, you may see quite a different side to them if you meet socially. However, in mental health, the word personality refers to the collection of characteristics or traits that makes each of us an individual. These include the ways that we:
By our late teens, or early 20s, most of us have developed our own personality with our own distinctive ways of thinking, feeling and behaving; the brain is still forming until we are about 21 and thoughts, beliefs, and character are still developing. It then remains pretty much the same for the rest of our life from then on. Usually, our personality allows us to get on reasonably well, if not perfectly, with other people.
For some of us, this doesn't happen. For whatever reason, parts of our personality develop in a way that makes it difficult for us to live with ourselves and/or other people. It can be difficult to learn from experience and to change those traits, the unhelpful ways of thinking, feeling and behaving that cause the problems. Unlike the changes in personality that can be caused by traumatic events, or an injury to the brain, these traits will usually have been noticeable from childhood or early teens.
You may find it difficult to:
If, as a result, you are unhappy or distressed find that you often upset or harm other people then you may have a personality disorder. Having a personality disorder makes life difficult, so other mental health problems, such as depression, self harming, drug and alcohol problems are also common.
There are different ways to describe mental disorders, and to put them into categories. The difficulty in describing any personality clearly, makes this more controversial with personality problems than with mental illnesses, such as depression or schizophrenia. Many people feel that it is unhelpful to label personality difficulties in this way. However, although we are all individuals, certain patterns of personality problems do seem to be shared by fairly large numbers of people. By identifying these patterns, we can then develop ways of helping, and treatments that can be of use to many people, not just an individual. Some say that a particular way in the world that looks different to others’ is just as natural, even if it is socially unacceptable by the majority. We a conditioned by what is perceived as right and wrong in societies we are brought up in.
There is good evidence that people with the diagnosis of personality disorder have not received the attention they should have from mental health services. There has been some uncertainty about whether they have anything useful to offer people with personality disorders. Research has made it clear that mental health services can, and should, help people with personality disorders
Research has shown that personality disorders tend to fall into three groups, according to their emotional 'flavour':
As you read through the descriptions of each type and perhaps identify with it partially, this does not mean you have a clearly defined personality disorder. We could all identify with some or all of the presentations from time to time. Some of these characteristics may even be helpful in some areas of your life. However, if you do have a personality disorder, these aspects of your personality will be quite extreme. They may spoil your life, and often the lives of those around you.
People may display the signs of more than one personality disorder.
What causes personality disorders is not clear, but it seems that like other mental disorders, genes, brain problems and upbringing can play a part. There is evidence for the importance of:
Upbringing:
If children are taken out of this sort of difficult environment, they are less likely to develop a personality disorder.
Early problems:
Behaviour problems in childhood, such as severe aggression, disobedience, and repeated temper tantrums.
Brain problems:
Some people with antisocial personality disorder have very slight differences in the structure of their brains, and in the way some chemicals work in their brains. However, there is no brain scan or blood test for a personality disorder.
Things that make it worse:
Treatment for people with personality disorders can be psychological, such as talking therapies, and physical, such as medication.
Counselling or therapy, talking and listening to feedback. This depends on a trusting relationship between the counsellor and the person counselled. Many forms of therapy exist but a nurturing, non critical model is likely to be most helpful. This is to not increase the levels of anxiety already present in the person.
Residential treatment in a therapeutic community is known to be helpful and effective. Most of the work is done in groups, so there is a shared experience. You learn from getting on, or not getting on with other residents what your defences are. It differs from real life in that any disagreements or upsets happen in a safe place, new skills and strategies are taught and learnt, but people have to be prepared to stay and work through difficult periods.
Medication can help in some personality disorders.
Antipsychotic drugs:
Mood stabilisers:
Medication such as lithium, carbamazepine, and sodium valproate can also reduce impulsiveness and aggression.
If you have a personality disorder, you may not need treatment at all, but you might find medication or therapy helpful, and sometimes both. Admission to hospital usually happens only as a last resort, perhaps when a person with borderline personality disorder is harming themselves badly, and for a short time.
Yes. There is evidence that they tend to improve slowly with age. Antisocial behaviour and impulsiveness, in particular, seem to reduce in your 30s and 40s.
It can, however, sometimes work in the opposite direction. For example, schizotypal personality disorder can develop into the mental illness schizophrenia.
People with a personality disorder, just like anyone who has mental health difficulties, can be stigmatised because of their diagnosis. They can attract fear, anger and disapproval rather than compassion, support and understanding. This is both unfair and unhelpful. Personality disorder is a real problem that demands real help. We can all help by extending our friendship, support and understanding, rather than our judgement and discrimination, to people with a personality disorder.
TRN strongly advise you to seek professional help if you are concerned that you or someone close to you presents with a personality disorder. ASK FOR HELP
